Professor Eiji Yano raises a number of issues in his letter(1) which
responded to my commentary(2) on his article(3) about the Japanese spousal
study, as does Chapman in his editorial(4). Here I reply to the main
points raised.
INTERPRETATION OF THE DATA
Studies of environmental tobacco smoke (ETS) exposure and lung cancer
commonly identify a...
Professor Eiji Yano raises a number of issues in his letter(1) which
responded to my commentary(2) on his article(3) about the Japanese spousal
study, as does Chapman in his editorial(4). Here I reply to the main
points raised.
INTERPRETATION OF THE DATA
Studies of environmental tobacco smoke (ETS) exposure and lung cancer
commonly identify a group of self-reported non-smoking women and then
compare risk according to the smoking habits of the husband. If some true
smokers are erroneously included among the female subjects, an apparent
relationship of spousal smoking with lung cancer may be seen even when no
true effect of ETS exists. This has been mathematically demonstrated
(e.g.5), with attempts to correct for it made by major independent
authoritative reviews of the evidence on passive smoking and lung
cancer.(6-8) The magnitude of the bias depends (among other things) on
the extent to which women who smoke are misclassified as non-smokers. It
can also be shown mathematically(5) that a given rate of misclassification
of smokers as non-smokers is a much more important cause of bias than is
the same rate of the reverse misclassification, of non-smokers as smokers.
Since such reverse misclassification is also implausible, adult women
having little reason to claim erroneously to be smokers, the major
reviews(6-8) have all ignored its minor effects.
Given that in the Japanese spousal study (using a urinary
cotinine/creatinine ratio, CCR, above 100 ng/mg as an index of true
smoking), the reverse misclassification rate (8/298 = 2.7%) was anyway
much lower than the misclassification rate itself (28/98 = 28.6%), it
becomes abundantly clear that reverse misclassification is not relevant to
the passive smoking/lung cancer issue. It is difficult to understand why
Yano places such emphasis on it.
Yano(1) states that I am "confused with the calculation formula" and
that my "definition of misclassification was obtained by dividing those
with >100 ng/mg CCR (n = 28) by self-reported non-smokers (n = 318)."
It appears that Yano himself is confused. I had previously made it
clear(2) that the denominator should not be 318, but 98, the number of
women with a CCR value indicative of smoking (or perhaps 106, if one also
includes those women who claimed to smoke but had a CCR <100 ng/ml).
The misclassification rate calculation is clearly based on CCR
>100 ng/mg validly indicating smoking. Such an assumption is widely
used(9), though may be subject to some error, and was the best technique
available at the time. Most smokers admit to smoking, so that self-report
has some validity as an indicator of true smoking status, but this does
not help us estimate the magnitude of the misclassification bias. The
observed lack of correlation in the Japanese spousal study between CCR in
non-smokers (with CCR <100 ng/mg) and other indices of ETS exposure
suggests that inaccuracy in CCR measurement at low levels may be
important. However, such inaccuracy may not be relevant to the
misclassification rate calculation, which merely attempts to use CCR to
distinguish smokers from non-smokers. Over half the self-reported non-
smokers with values over 100 ng/mg actually had values of 1000 ng/mg, and
it would be very surprising indeed if errors in CCR measurement were so
huge that these women were really non-smokers.
Though I would be happy to see results of further studies using up-to
-date state-of-the-art chemical methods to detect nicotine metabolites in
self-reported non-smokers, the conclusion I reached in 1995 that
misclassification rates are much higher in Japanese than in Western
populations(10) seems to be correct. I note that the existence of high
misclassification rates in Asian women has in fact been independently
confirmed.(11)
RIGHTS TO PUBLICATION OF THE FINDINGS
Yano states(1) that I used his data without his consent. As far as I
am aware, the data never belonged to Yano. The study had been funded by
the industry who had carried out the cotinine analyses (blind of self-
reported smoking status). I had originally proposed that the study be
done, following conduct of a similar study in England, which the industry
supported at my request, and which I reported the results of.(12) The
original intention had been for Yano to be a major author, but problems
arose because his interpretation of the findings differed materially from
mine, due to his misunderstanding of the complexities of
misclassification. Discussions took place between Yano and Proctor, who
played an important role in planning and organisation of the study on
behalf of the tobacco companies who funded it, and I was told that these
discussions led to Yano deciding not to be an author, and to his
understanding that the work would be published by others.
I had assumed that Proctor would keep Yano informed about the status
of the publication and was surprised Yano did not find out about the
paper, published in 1995, until some 7 or 8 years later. Clearly, one of
us should have kept him informed, and for this I apologise. In his
original article,(3) Yano states that "at no stage in my interactions with
Proctor was Lee's name or role ever mentioned." This is surprising
inasmuch as the study proposal stated that I would assist in reviewing the
study design and in interpreting the data. Was Yano really unaware of the
previous literature on misclassification of smoking, in which I figured
prominently (see 2) when conducting a study, a major aim of which
concerned the determination of misclassification rates?
GHOST AUTHORSHIP
Chapman(4) considers that "it is hard to imagine a more flagrant example
of attempted ghost authorship". It is difficult to see why Chapman sees
the publication as ghost authorship at all, when I proposed the study,
helped in its design and then published it. The study was a joint
enterprise, as I saw it, and it is perfectly normal for some of the
scientists involved in a study to write a draft for others to agree to.
It would clearly have been better had a version acceptable to all, with
Yano in the author list, been published. However, Yano's failure to
understand the mathematics of misclassification made this impossible.
There was no agreement I am aware of that Yano had sole rights to
authorship. Had I not published the paper(10) it seems that the findings
would never have appeared in the public domain at all. Did Yano also
have sole rights to suppress the findings?
POSTSCRIPT
At the end of the day it is interesting that, though the evidence of high
misclassification rates in Japanese women has been independently
confirmed,(11) the relevance of this to the ETS/lung cancer relationship
has been ignored in recent major reviews of ETS and lung cancer
(e.g.8,13). I have demonstrated the major biasing effect of this finding
in detail elsewhere(14).
References
1. Yano E. Response to P N Lee [Commentary]. Tob Control
2005;14:234-5.
2. Lee PN. Japanese spousal study: a response to Professor Yano's
claims [Commentary]. Tob Control 2005;14:233-4.
3. Yano E. Japanese spousal smoking study revisited: how a tobacco
industry funded paper reached erroneous conclusions. Tob Control
2005;14:227-35.
4. Chapman S. Research from tobacco industry affiliated authors:
need for particular vigilance [Editorial]. Tob Control 2005;14:217-9.
5. Lee PN, Forey BA. Misclassification of smoking habits as a
source of bias in the study of environmental tobacco smoke and lung
cancer. Stat Med 1996;15:581-605.
6. Committee on Passive Smoking, Board on Environmental Studies and
Toxicology, National Research Council. Environmental tobacco smoke.
Measuring exposures and assessing health effects. Washington D.C.:
National Academy Press; 1986.
7. National Cancer Institute. Shopland DR, editor. Respiratory
health effects of passive smoking: lung cancer and other disorders. The
report of the US Environmental Protection Agency. USA: US Department of
Health and Human Services, Public Health Service, National Institutes of
Health; 1993. (Smoking and Tobacco Control. Monograph 4.) NIH Publication
No 93-3605.
8. Hackshaw AK, Law MR, Wald NJ. The accumulated evidence on lung
cancer and environmental tobacco smoke. BMJ 1997;315:980-8.
9. Lee PN, Forey BA. Misclassification of smoking habits as
determined by cotinine or by repeated self-report - a summary of evidence
from 42 studies. J Smoking-Related Dis 1995;6:109-29.
10. Lee PN. "Marriage to a smoker" may not be a valid marker of
exposure in studies relating environmental tobacco smoke to risk of lung
cancer in Japanese non-smoking women. Int Arch Occup Environ Health
1995;67:287-94.
11. Lee PN. Passive smoking and lung cancer: Strength of evidence
on passive smoking and lung cancer is overstated [Letter]. BMJ
1998;317:346-7.
12. Lee PN. Lung cancer and passive smoking: association an
artefact due to misclassification of smoking habits? Toxicol Lett
1987;35:157-62.
13. International Agency for Research on Cancer. Tobacco smoke and
involuntary smoking, Volume 83. Lyon, France: IARC; 2004. (IARC Monographs
on the evaluation of carcinogenic risks to humans.)
14. Lee PN, Forey BA, Fry JS. Revisiting the association between
environmental tobacco smoke exposure and lung cancer risk. III. Adjustment
for the biasing effect of misclassification of smoking habits. Indoor
Built Environ 2001;10:384-98.
Allowing the tobacco industry to define "reasonable regulation," an
industry whose economic survival will always depend upon finding new and
creative ways to entice children and teens into permanent chemical
enslavement, is like allowing Hitler to write health standards for dead
camps.
While awaiting fine-tuning of FDA regulatory bills, it's time for the
U....
Allowing the tobacco industry to define "reasonable regulation," an
industry whose economic survival will always depend upon finding new and
creative ways to entice children and teens into permanent chemical
enslavement, is like allowing Hitler to write health standards for dead
camps.
While awaiting fine-tuning of FDA regulatory bills, it's time for the
U.S. Congress to expressly allow cities and states to take immediate steps
to insulate youth from all corporate image, newspaper, magazine,
sponsorship, and point of sale tobacco industry marketing.
Two decades of selective binding technology could immediately allow
entire zip codes to be free of all magazine and newspaper tobacco ads, if
local governments were only granted authority to protect their youth.
Modern dependency science has taught us that history is a ridiculous
excuse for demanding that high grade ethanol products be sold in stand
alone liquor stores, while high grade nicotine delivery devices are
marketed inside a child's neighborhood candy, chip and soda store.
With almost a half a million annual U.S. deaths, it's beyond time
that point of sale marketing was no long visible from sidewalks or school
buses. It's beyond time to grant local government express authority to
exclude youth from all tobacco sales locations.
Inside adult only sales locations, allow the industry to advertise
and market to its heart's content. But no pictures in ads or displays,
other than the product, and grant local government authority to demand
premises dependency warning signs.
I enjoyed Derek Yach’s editorial. I believe that the FCTC and new
research that will support its transnational aspects can make a big
difference. But will they?
I would warn against over optimism and for an understanding of the
commitment and sustained action that will be required. First, one must
face the fact that the primary governance of tobacco issues has been and
continues to be located in the tobacco...
I enjoyed Derek Yach’s editorial. I believe that the FCTC and new
research that will support its transnational aspects can make a big
difference. But will they?
I would warn against over optimism and for an understanding of the
commitment and sustained action that will be required. First, one must
face the fact that the primary governance of tobacco issues has been and
continues to be located in the tobacco business. This has been and could
continue to be the case for many years since the tobacco industry spends
more money than national and supranational bodies on controlling tobacco
governance. They also spend it using both legal and illegal means
necessary to their objectives. They also spend it with monopolistic focus
and agreement on core issues.
In contrast, to believe that there is some kind of international, or
even focused national governance of tobacco control is just not supported
by the evidence. Many countries have no central organization to forward
national tobacco control planning and policy, no plan for research, no
systematic monitoring of even the most basic indicators of importance to
tobacco control, and little or no money to fund tobacco control. And
while the fact that the FCTC requires more from these nations, without
adequate funding and sustained commitment, the lack of national governance
is likely to continue and the chance of global governance to be only a
remote dream.
How does a country get the necessary money and the necessary
commitment? Suppose you are from a poor country with a population of 25
million. What if you convinced society, including politicians and
scientists that they need to immediately bring tobacco use to a very
limited level? What if you could get $3 per person per year dedicated to
this job through taxing the tobacco industry? If you had the money and
the commitment, you could possibly make rapid progress through a
comprehensive approach to governing tobacco supply and demand.
Some countries have done so already. So where is the worldwide push
and coordination for all countries to generate funding and political will?
Until there is more effort in this direction, I doubt there will ever be a
global governance system for tobacco control. Urgency is appropriate, but
considering the historical record and present lack of money and
commitment, I believe slow progress is more likely. I wish I were wrong.
Erratum to Mandel, L; BC Alamar; and SA Glantz, “Smokefree Law did not affect revenue from
gaming in Delaware” Tobacco Control 14 (2005), 10-12.
The results in the original publication reflect a data entry error. The revised table in
this erratum present the results with this error corrected. Using the corrected data, White's test
for heteroskedasticity rejected homoskedasticity (p = 0.016) in t...
Erratum to Mandel, L; BC Alamar; and SA Glantz, “Smokefree Law did not affect revenue from
gaming in Delaware” Tobacco Control 14 (2005), 10-12.
The results in the original publication reflect a data entry error. The revised table in
this erratum present the results with this error corrected. Using the corrected data, White's test
for heteroskedasticity rejected homoskedasticity (p = 0.016) in the case of total revenues. We
corrected for the heteroskedasticity in total revenues by using a weighted least squares analysis
using the inverse of the number of video lottery machines as the weight. White's test of the
residuals from the weighted regression did not reject homoskedasticity (p=0.293). Average
revenues were homoskedastic (p=0.13) so we continued to use an unweighted regression, as in
the original paper. The analysis based on the corrected data confirms the results of the published
paper, that the smokefree law had no effect on revenue from gaming in Delaware.
In their article, Anderson, Glantz and Ling explore messages of
psychosocial needs satisfaction in cigarette advertising targeting women.
We agree with the authors that counter-advertising should attempt to
“expose and undermine the needs satisfaction messages of cigarette
advertising”. They mention that “a message of escape from life’s hassles
could be countered with a message that addiction further complicates an
al...
In their article, Anderson, Glantz and Ling explore messages of
psychosocial needs satisfaction in cigarette advertising targeting women.
We agree with the authors that counter-advertising should attempt to
“expose and undermine the needs satisfaction messages of cigarette
advertising”. They mention that “a message of escape from life’s hassles
could be countered with a message that addiction further complicates an
already hassle-ridden life”. During the past two years, the Healthy
Community Coalition (HCC) has conducted an anonymous survey in order to
gather data on the smoking behaviors of low-income, postpartum women and
their partners in rural Greater Franklin County, an area in western Maine
larger than Rhode Island with a population density of 17 people per square
mile. The study sample included every mother who gave birth during the
past two years at the sole hospital serving the area and completed the
self-administered survey. Their husbands/partners were given a very
similar survey to complete with questions addressing their own smoking
behaviors. Results show that smoking among the low-income, postpartum
women declined from 33.3% at baseline to 27.5% at end of study. One reason
for this decline can be attributed to the HCC program, “Tobacco Free
Franklin Families”, which uses funding from the American Legacy Foundation
to reduce smoking among low-income families through innovative approaches,
such as stress-reduction workshops for low-income mothers and their
partners.
Multivariate analysis of the mothers’ survey data showed that living
with someone who smokes was the most powerful risk factor associated with
postpartum smoking. Studies show that living with someone who smokes
increases up to four times the odds that the postpartum mother will return
to smoking. Multivariate analysis also indicated that a mother who was
unemployed or disabled was significantly more likely to smoke, as well as
a mother who was unmarried or did not have a partner. We recommend
innovative counter-advertising which shows that smoking only adds another
stressor to the women’s lives. Over a quarter of the mothers (26.5%)
reported that in the past twelve months, they or their husband/partner had
lost a job; 29.1% often worried that the food in their household would run
out before they had money to buy more; and 37.6% often worried about
heating their home during the winter. These statistics are consistent
with the latest U.S. Census data which show that 46.7% of the children in
Franklin County live in low-income families. The counter-advertising
might also include humor since 92% of the mothers who smoked were
interested in learning how to use humor to deal with stress. Other ad
campaigns targeting the partner are also strongly recommended since the
vast majority of studies have shown partner smoking to be the main
predictor of women smoking postpartum. The counter-advertisements should
address psychosocial needs of the husbands/partners. Like the mothers,
the partners reported a high prevalence of the same stressors: 23.9% often
worried that the food in their household would run out before they had
money to buy more and 40.2% often worried about heating their home during
the winter.
Kathleen J. Welch, Ph.D., MPH, Katherine A. Marble, CHES, TTS-c
About the authors: Dr. Kathleen Welch is the epidemiologist/evaluator
for the Healthy Community Coalition's project, Tobacco Free Franklin
Families. Katherine Marble is Program Coordinator for Tobacco Free
Franklin Families. The HCC is an affiliate of the Franklin Community
Health Network located in Farmington, Maine.
References
1. Anderson SJ, Glantz SA, Ling PM. Emotions for sale: cigarette
advertising and women’s psychosocial needs. Tobacco Control. 2005;14:127-
135.
2. U.S. Census Bureau. (2000). Current population survey. Retrieved
April 26, 2005, from http://www.census.gov/apsd/techdoc/cps/cpsmar00.pdf.
3. Cohen S, Lichenstein E. Partner behaviors that support quitting
smoking. Journal of Consulting and Clinical Psychology. 1990;58:304-309.
4. Maine Children’s Alliance, Maine KIDS COUNT (2004). Retrieved
April 26, 2005, from http://www.mekids.org
5. Ratner PA, Johnson JL, Bottorff JL, Dahinten S, Hall W. Twelve-
month follow-up of a smoking relapse prevention intervention for
postpartum women. Addictive Behaviors. 2000;25:81-92.
In June 2002, months before this column was published, I published an essay
in a number of Nigerian newspapers entitled: "The 17 Billion Poison House
In Ibadan." The piece was my own way of pouring out my spilling disgust
and accumulated indignation because of reports in the media earlier in
April of the same year that the Obasanjo Administration had celebratorily
granted permission to a so-called "leading cigarette comp...
In June 2002, months before this column was published, I published an essay
in a number of Nigerian newspapers entitled: "The 17 Billion Poison House
In Ibadan." The piece was my own way of pouring out my spilling disgust
and accumulated indignation because of reports in the media earlier in
April of the same year that the Obasanjo Administration had celebratorily
granted permission to a so-called "leading cigarette company", British
America Tobacco (BAT), to invest a "whopping $150 million (about 17
billion naira)" in the construction of a tobacco factory in Ibadan, "the
biggest and most modern" of its kind in Africa. The prominent attraction
of the company, according to reports, was that, when completed, it would
provide employment to 1,000 Nigerians.
Expectedly, the article provoked immense interest, and was rewarded
with an unimaginably wide circulation on the Internet. In fact, I have
continued to see several links to it on a number of internet sites,
including TOBACCO.ORG. Indeed, Op-Ed News which still maintains a link to
the piece describes it as "Talking about Tobacco like we Never See in
the US" (The piece is still available on the net at:
http://www.usafricaonline.com/tobaccongr.ugoejinke.html).
I even got a letter from an attorney in Houston requesting more
information about the activities of British America Tobacco and other
cigarette companies in Nigeria so he could commence legal action against
them in order to force them and their lethal business out of Nigeria.
What amazed me after the publications, was the panic reaction of BAT.
They immediately mounted an unprecedented image-packaging blitz through
countless full-page glossy adverts in several newspaper and magazines.
Today, I am reopening this battle, not just with BAT now, but with
all other cigarette manufacturers in this country, and I invite all
concerned Nigerians, health and environmental activists, to join this
clearly winnable struggle. The question I have always asked cigarette
producers is: can they boldly come out in the open and assure me that the
commodity they manufacture and distribute to hapless individuals cannot be
rightly classified as poison? Again, they should tell me just one single
benefit the human body derives from cigarette smoking. Has it not been
convincingly proved everywhere, and publicly admitted by tobacco
producers, that tobacco is a merciless killer, an unrelenting cannibal
that devours a man when his life is sweetest to him? If then tobacco is a
proven killer, can’t those who manufacture and circulate it in society be
classified as murderers? Hasn’t even our own Federal Ministry of Health
unambiguously endorsed this position by its insistence and persistent
warning that TOBACCO SMOKERS ARE LIABLE TO DIE YOUNG?
The implication of the Health Ministry’s statement is simple: If
tobacco smokers are liable to die young, then anyone offering you a
cigarette is only informing you that the best wish he could possibly make
to you is that your life be cut short! He is just telling you in very
clear terms: May you die young! And that is exactly what BAT, other
tobacco companies, and the government that licensed them to operate here
are wishing Nigerians! How wicked and heartless could they be!
I know that after this piece now, BAT and their co-poison
manufacturers will start again to erect new and more beautiful billboards,
and fill several pages of newspapers with glossy adverts. I see this as
nothing but the huge, shameless strategem of a smiling, gentle, but
ruthless murderer to persuade his victims to allow him to live among them
so he could strike when they least expected. Well, this time around, I am
waiting for them to boldly tell Nigerians that tobacco, the product they
manufacture and circulate in Nigeria, is no more the resilient,
implacable, silent killer, the lethal poison, and the heartless cannibal
that seeks accommodation in the midst of hapless humanity with the sole
intention of effecting their eventual decimation. I want to hear that
cigarettes are no longer generous distributors of devouring cancer,
tuberculosis, sundry terminal lung and heart diseases, etc.
Unfortunately, cigarette adverts are among the most alluring in
society. The pleasant pictures of vivacious achievers smiling home with
glittering laurels just because they are hooked to particular brands of
cigarette which we see on glossy billboards are proving irresistible baits
to several people, especially youths. The danger is so evident in the
unparalleled glee with which youths adopt these cigarette adverts stars as
their most cherished heroes and models. I was a victim too. As a youth,
the elegant, gallant, athletic rodeo man whose image marketed the 555
brand of cigarette was my best idea of a handsome, hard-working winner. My
friends and I admired him, carried his photographs about, and yearned to
smoke 555 in order to grow up and become energetic and vivacious like him.
One wonders how many youths that have been terminally impaired
because they went beyond mere fantasies and obsession with their cigarette
advert heroes and became chain-smokers and irredeemable addicts. Managers
of tobacco adverts are so adept in this grand art of deception that their
victims never suspect any harm until they have willingly placed their
heads on the slaughter slab. Indeed, only very few are able to look beyond
the deceptive pictures and the pernicious pomp of cigarette promotional
stunts and see the blood-curdling pictures of piecemeally ruined lungs and
other sensitive organs, murky, chimney-like breath tracts and heart
region, the looming merciless and spine-chilling fangs of an all devouring
cancer, tuberculosis, sundry lung and heart diseases, and their associate
unyielding killers. The warm reception given to BAT in Nigeria by both the
Federal and Oyo State governments is nothing but criminal, ungodly and
anti-people.
There were reports that BAT paid 2billoin naira tax in 2001. I have
even heard that it sponsors scholarships and community help projects. But
how many people have their lethal product sent to their early graves? How
many widows, widowers and orphans are they producing with alarming
rapidity? How many among their 1,000 employees are gradually ruined
daily because of the insidious fumes they inhale during production of
cigarettes? How many cancer, TB, lung disease patients do they produce in
a year?
Indeed, in civilized countries, Tobacco Companies and their owners
are being isolated and choked with harsh laws. Now, they have invaded
Nigeria with their filthy billions because we have an incompetent and
insensitive government that has no qualms welcoming urbane, but ruthless
killers in the name of “foreign investors.”
The development in the United States on June 7, 2001 where a Los
Angeles Superior Court in California slapped an unprecedented $3 Billion
in damages on Phillip Morris, another giant Tobacco Company in response to
a suit by a tobacco casualty, Richard Boeken, who had developed incurable
cancer of the brain and lungs after smoking two packs of Marlboro
cigarettes every day for 40 years should serve as eye opener to Nigerians
that with several class suits from victims of tobacco, these evil
merchants can be forced out of Nigeria. According to the New York Post
editorial of June 9, 2001, 56-year-old Boeken who began smoking as a
teenager in 1957 claimed that "he continued smoking not because it was
addictive, but he believed claims by Tobacco Companies that smoking was
safe." He told reporters in a post-trial interview: " I didn’t believe
they would lie about the facts that they were putting out on television
and radio."
That is exactly the point. Tobacco companies are deploying well
concocted lies to lure people into taking their fatally poisoned wraps
called cigarettes. Their billboards present vivacious winners and
achievers puffing away, instead of cancer patients treading the cold,
dark, lonely path to a most painful, slow death. Every society has a
responsibility to defend its unwary and the ignorant. Nigeria cannot be an
exception. The argument that smokers ought to be dissuaded from smoking by
the hardly visible warnings they put out, and that people are merely being
allowed to exercise their right and freedom to make choices, is akin to
endorsing suicide as a lawful __expression of freedom? Why allow a killer-
poison to circulate in the first place? Do we all have the same capacity
to discern and resist the allurement of danger? In court and in several
enquiries, tobacco producers have admitted that their product contains
very harmful substances. It is widely believed that many Tobacco producers
are non-smokers because they know too well how deadly their product is!
Tobacco is a killer. So are its manufacturers. Nigerians should rise and
resist this cannibal in our midst. Certainly in several families, there
have been tobacco victims. There are relevant laws under which these
people can be sued. You have a choice in this matter, to not only refuse
to patronize their lethal product but to help your hapless, less-
discerning neighbour do likewise. This fight is winnable.
P/S: For more information about the destructive mission of tobacco,
log on to http://www.tobaccofree.org/children.htm
To: BAT Nigeria Limited Mr. Kehinde Johnson Corporate &
Regulatory Affairs Director
"Should we swallow a bait and have a lethal hook thrust in our
throats just because the bait looked so appealingly delicious? What the
tobacco companies manufacture has no single benefit, no redeeming feature.
All it does is to kill and ruin .They are unwanted, loathsome and
unwelcome "(Ugochukwu D. Ejinkeonye- The Black Busi...
To: BAT Nigeria Limited Mr. Kehinde Johnson Corporate &
Regulatory Affairs Director
"Should we swallow a bait and have a lethal hook thrust in our
throats just because the bait looked so appealingly delicious? What the
tobacco companies manufacture has no single benefit, no redeeming feature.
All it does is to kill and ruin .They are unwanted, loathsome and
unwelcome "(Ugochukwu D. Ejinkeonye- The Black Business Journal )
Dear Sir,
Was the Standards Organisation of Nigeria (SON) able to determine:
• how many « risky » ingredients does BAT-Nigeria add to its
cigarettes ?
• how many toxic chemicals are there in BAT-Nigeria’s cigarettes’
smoke ?
• if there is more than the FDA 600 permitted additives to the
tobacco in the counterfeit cigarettes ?
• if there is more than 4000 toxic chemicals in the counterfeit
cigarettes’ smoke ?
What are the ‘prescribed limits for tobacco products’ in Nigeria ? Do
these limits guarantee the SAFETY of these products ?
Are the ‘genuine brands’ manufactured in BAT-Nigeria Ltd nicotine-
drug delivery devices that affect the health of smokers and that of the
people around them less than the counterfeit cigarettes do? How much less?
Do we have some comparative epidemiological studies on that issue?
Could your ‘well documented position on smoking and health and published
on our website’ give us these details?
BAT-Nigeria Ltd is ‘working in collaboration with the Nigerian
government’. Perhaps you mean the Minister of Commerce, Hon A.D Idris
Waziri who was present at the shameful BAT investor award ceremony or Hon
Kola Jamodu, the Minister of Industry
(http://www.summitreports.com/nigeria1/tobacco.htm), or the President
Olusegun Obasanjo who’s reforms ‘greatly encouraged BAT
(http://news.bbc.co.uk/2/low/business/1561228.stm)
However, the Minister of Health rightly abstained from your meeting
of your Social Report.
Your business is profit on a highly addictive, risky and lethal
product, our concern is health and quality of life.
Ms. Véronique Le Clézio Manager de ViSa- Mauritius ViSa Mauritius
Tobacco leaves which are used for manufacturing cigarettes are
cultivated by the tobacco industry themselves, throughout the world.
If the tobacco industry is honestly keen in stopping the availability of
counterfeit cigarettes on this earth, they should first of all stop
cultivating tobacco leaves. One of the strategies that the industry
employs to protect their business is to misuse the illicit cigarette
in...
Tobacco leaves which are used for manufacturing cigarettes are
cultivated by the tobacco industry themselves, throughout the world.
If the tobacco industry is honestly keen in stopping the availability of
counterfeit cigarettes on this earth, they should first of all stop
cultivating tobacco leaves. One of the strategies that the industry
employs to protect their business is to misuse the illicit cigarette
industry.
Also they use the illegal cigarette industry to get the maximum
support from the government, i.e. to justify the industry promotions being
launched to capture customers, especially the children, to reduce prices,
to increase the market share etc.
In many countries, tobacco industry is a monopoly. Therefore there is
no question of price decrease or the need to justify promotions. As such
the illegal cigarette industry represents as an invisible competitor. For
instance, in Sri Lanka Ceylon Tobacco Company (CTC) always insists the
government not to increase the price of cigarettes in an affecting amount,
put forwarding logics that such decision would increase the consumption
and availability of illegal cigarettes.
They then say that the government's revenue would go down, if the
availability of illegal cigarettes increases due to price increase of
legal cigarettes. As they put such arguments the government does not
increase the price of legal products at all.
The tobacco industry needs promotions to increase the consumption.
But amidst the protest being made against the company by several sectors
in the society, the government has to control it even to a certain extent.
In such circumstances carrying out of such promotions by the industry
effectively is not that easy. Therefore they always pressurize the
government that it needs to promote the legal industry in order to
decrease the market for illegal cigarettes.
The best strategy and the support for the tobacco industry throughout
the world is the illegal industry. It is how the industry earns huge
amounts of money to spend for their propaganda work, especially to capture
politicians, policy makers, media personnel etc. It is a known secret that
the illegal cigarette industry is being maintained by the legal industry!
I had the opportunity to interview the officials of the illegal cigarette
manufacturers in Sri Lanka and they revealed that it was the legal
cigarette industry who supported them to set up the industry and even raw
material and machinery were provided to them by the legal industry at the
initiation process of the business.
Finally, with regard to the statement made by the Managing Director
of British American Tobacco, Nigeria, "tobacco use is risky, but
counterfeit cigarettes are lethal." Mr. Manager could you please define
the extent of this risk and how would the risk affect the consumer and the
benefit of the product? Also, when you say ¡°lethal¡± how do you justify
this?
Ron Davis finds my analogy weak when I liken employers not hiring
smokers (because as a class they take more time off work) to not hiring
women of child-bearing age (because they may become pregnant or take time
off for childcare). He notes that in the USA (as indeed in many nations)
there are laws outlawing labour discrimination on the basis of sex or age,
but not discrimination based on smoking status. Some nations also...
Ron Davis finds my analogy weak when I liken employers not hiring
smokers (because as a class they take more time off work) to not hiring
women of child-bearing age (because they may become pregnant or take time
off for childcare). He notes that in the USA (as indeed in many nations)
there are laws outlawing labour discrimination on the basis of sex or age,
but not discrimination based on smoking status. Some nations also forbid
discrimination based on sexual preference, race and religion in such laws.
He adds that sex and age are immutable, whereas smoking is at least in
principle amenable to choice.
I would defend my analogy by pointing not to the differing legal
status of smoking and sex (or age) discrimination, but to the parallel
matters of principle that have been responsible for the outlawing of
various forms of discrimination. We have laws preventing sex, age and race
discrimination because to allow discrimination would be to allow non-
relevant and unjust barriers to intrude in decisions about capability and
suitability to do a job.
This principle is precisely that which I believe applies to the class
“smokers”. As I argued, while it is true that smokers as a class take more
time off (to smoke and when ill) than do non-smokers, this is not the case
for every smoker.
In my response to Nigel Gray, I was careful to emphasise that
employers have every right to select staff whose presentation and skills
accord with the needs of employers. I would concur completely with Ron’s
examples of some restaurateurs being unwilling to hire people with strange
appearance as being legitimate (although in my suburb, such appearance is
fast becoming mandatory!). However, such policies are all about work
performance and company image. Hair colour is seldom changed every
evening, but many smokers only smoke away from work.
Ron raises the practice of insurance companies levying higher policy
rates based on “class averages” (such as higher premiums for young
drivers, despite many individual young drivers having excellent driving
records and abilities), and argues that by the same reasoning, employers
could take the same “class risk” attitude to smokers. Again, I believe his
argument here is imperfect. It would, as he argues, be “impractical or
impossible” to predict which young drivers will crash, but it is not
impractical or impossible for an employer with good management systems and
skills to know which smoking employees are a drain on a company and which
are not. Indeed, many insurance companies annually adjust individual
policies depending on the insured person’s claims in a preceding period.
I have no problem whatsoever with an employer insisting that
employees do not smoke at work for reasons of corporate image, safety or
of course harming others. But what of the many highly valued and
productive smokers who only smoke away from work – the people I am talking
about in this debate? If this debate were oxygenated and it became common
practice for employers to not hire smokers, it is conceivable that this
“movement” would add extra pressure on smokers to quit. That would be a
good outcome, but it would be achieved by coercion which I do not regard
as ethical in the absence of preventing harm to others.
Ron also rejects what he calls my slippery slope analogies whereby
employers would -- by evoking the same concerns -- have the right to
enquire about whether employees engaged in high risk activities such as
skiing, motor-cycle riding, or body contact sport such as the game of
rugby (in which Australians dominate all other nations!), all of which
significantly increase the risk of time being taken off work. While Ron’s
philosophy professor shows how slippery slope arguments can violate logic,
I remain unconvinced that there are any errors in logic in an employer
reasoning “smokers are at higher risk of illness and time-off work. I will
not hire them” and “motorcyclists have a high risk of injury and
disability. I will not hire them.” My facetious example about voting for
conservative politics was intended as a reductio ad absurdum example of
how far employees might take an assumed right to know about out-of-working
-hours activities that might impact on employment.
I believe that out-of-hours smoking should be regarded as relevant to
a decision on employment of an individual (hiring or firing) only when
it can be shown to be affecting work performance. I have few problems with
an employer firing an employee whose record of sick leave was
significantly higher than normal, particular where that sick leave was
attributable to a smoking which I agree with Ron, should not be construed
as something that is impossible to stop.
Response to E Yano and S Chapman
P N Lee
Professor Eiji Yano raises a number of issues in his letter(1) which responded to my commentary(2) on his article(3) about the Japanese spousal study, as does Chapman in his editorial(4). Here I reply to the main points raised.
INTERPRETATION OF THE DATA
Studies of environmental tobacco smoke (ETS) exposure and lung cancer commonly identify a...
An excellent PM documents review! Thanks!
Allowing the tobacco industry to define "reasonable regulation," an industry whose economic survival will always depend upon finding new and creative ways to entice children and teens into permanent chemical enslavement, is like allowing Hitler to write health standards for dead camps.
While awaiting fine-tuning of FDA regulatory bills, it's time for the U....
I enjoyed Derek Yach’s editorial. I believe that the FCTC and new research that will support its transnational aspects can make a big difference. But will they?
I would warn against over optimism and for an understanding of the commitment and sustained action that will be required. First, one must face the fact that the primary governance of tobacco issues has been and continues to be located in the tobacco...
Erratum to Mandel, L; BC Alamar; and SA Glantz, “Smokefree Law did not affect revenue from gaming in Delaware” Tobacco Control 14 (2005), 10-12.
The results in the original publication reflect a data entry error. The revised table in this erratum present the results with this error corrected. Using the corrected data, White's test for heteroskedasticity rejected homoskedasticity (p = 0.016) in t...
We would like to correct reference #68 in this article. The correct reference for the document is:
Brown and Willamson. (1980). No Title. Bates No. 544000497/544000504. http://legacy.library.ucsf.edu/tid/mgh10f00.
In their article, Anderson, Glantz and Ling explore messages of psychosocial needs satisfaction in cigarette advertising targeting women. We agree with the authors that counter-advertising should attempt to “expose and undermine the needs satisfaction messages of cigarette advertising”. They mention that “a message of escape from life’s hassles could be countered with a message that addiction further complicates an al...
In June 2002, months before this column was published, I published an essay in a number of Nigerian newspapers entitled: "The 17 Billion Poison House In Ibadan." The piece was my own way of pouring out my spilling disgust and accumulated indignation because of reports in the media earlier in April of the same year that the Obasanjo Administration had celebratorily granted permission to a so-called "leading cigarette comp...
To: BAT Nigeria Limited Mr. Kehinde Johnson Corporate & Regulatory Affairs Director
"Should we swallow a bait and have a lethal hook thrust in our throats just because the bait looked so appealingly delicious? What the tobacco companies manufacture has no single benefit, no redeeming feature. All it does is to kill and ruin .They are unwanted, loathsome and unwelcome "(Ugochukwu D. Ejinkeonye- The Black Busi...
Tobacco leaves which are used for manufacturing cigarettes are cultivated by the tobacco industry themselves, throughout the world.
If the tobacco industry is honestly keen in stopping the availability of counterfeit cigarettes on this earth, they should first of all stop cultivating tobacco leaves. One of the strategies that the industry employs to protect their business is to misuse the illicit cigarette in...
Ron Davis finds my analogy weak when I liken employers not hiring smokers (because as a class they take more time off work) to not hiring women of child-bearing age (because they may become pregnant or take time off for childcare). He notes that in the USA (as indeed in many nations) there are laws outlawing labour discrimination on the basis of sex or age, but not discrimination based on smoking status. Some nations also...
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